Glycemic control and the first use of oral antidiabetic agents among patients with type 2 diabetes mellitus

Abstract

Objective:

Examine how patients diagnosed with type 2 diabetes mellitus (T2DM) are treated with oral antidiabetic (OAD) agents and the relationship between treatment patterns and glycemic control.

Research design and methods:

Data were obtained from the i3 Invision Data Mart database (OptumInsight, Eden Prairie, MN, USA). The analyses examined 4627 individuals who received a first prescription for an OAD (with first date identified as index date) and received at least one HbA1c test in both the 1 year prior and 2 years post index date. Patients were categorized based upon their level of glycemic control pre index date and logistic multivariate analyses were used to examine the probability of a patient’s first treatment pattern change being a switch, augmentation, or discontinuation compared to continuation on the intent-to-treat (ITT) OAD.

Results:

Men tended to have worse glycemic control at OAD initiation. During the post-period, younger patients were more likely to switch, augment or discontinue therapy, while patients initially treated with metformin were more likely to switch or augment therapy. Results indicated that patients with moderate or poor glycemic control, compared to those with good glycemic control, were significantly more likely to switch or augment therapy. Practice patterns revealed minimal use of insulin although, on average, many patients were above target HbA1c levels at initiation. Interpretation of results are limited by the fact that only a small subset of patients had valid HbA1c data and that the analyses was not able to account for other factors, such as race and weight, that may also impact the analyses.

Conclusions:

Patient initial level of glycemic control was associated with changes in treatment patterns in the 2 years post initiation on an OAD, with patients with moderate or poor control more likely to switch or augment their ITT therapy, compared to individuals with good control.

Keywords::

• Diabetes
• Glycemic control
• Oral antidiabetic agents
• Treatment patterns

Transparency

Declaration of funding

This study was funded by Eli Lilly and Company.

Declaration of financial/other relationships

B.D.M. and E.L.E. are employees of Lilly. M.J.L. was a paid consultant on this project. All authors were full participants in this research project. B.D.M. and E.L.E. had primary responsibility for study design while M.J.L. had primary responsibility for the analyses.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors thank Patricia Platt of Health Metrics for assisting with the writing of the manuscript.